Metformin, diet cost-effective to avert diabetes

SAN DIEGO (Reuters) - Generic drug metformin is a cost-effective way to help prevent type 2 diabetes in people at high risk of developing the chronic condition, according to a new economic analysis.

The study also found that intensive lifestyle changes -- individually tailored weight loss and exercise -- have a higher cost, but are more likely to succeed, with a ratio of cost versus benefits in line with other common medical interventions such as blood pressure medication.

When savings in the cost of medical care were balanced against the cost of the interventions, over a 10-year period, metformin saved $30 while the lifestyle program cost $1,500 per person, according the National Institutes of Health-funded study.

"I'm really stunned by these findings," said Dr. James Meigs, a physician in the clinical epidemiology unit and diabetes research unit at Massachusetts General Hospital in Boston. He said the study could revolutionize intervention guidelines for high-risk patients.

Meigs, who was not involved in the study, was at a meeting of the American Diabetes Association in San Diego, where the research was presented.

The economic analysis came from seven years of follow-up on a national diabetes prevention trial that was stopped when it became obvious that patients in both treatment groups did far better than those being given a placebo pill.

Over 10 years, treatment with metformin, a low-cost generic that reduces blood sugar, was found to decrease the chance of developing diabetes by 18 percent in high-risk patients, while lifestyle changes cut the risk by 34 percent.

Researchers then conducted an economic analysis to project the long-term outcomes, in terms of cost and quality of life, for both intensive lifestyle intervention and treatment with metformin.

It found that over 10 years, usage of metformin saved money while improving health outcomes.

"This is an intervention that should become widely implemented," said Dr. William Herman, professor of internal medicine at the University of Michigan and the study's co-author.

He said that only one in 10 medical interventions -- including things like prenatal care, childhood vaccines and flu shots -- actually save money.

The study found that the lifestyle intervention program, which aimed for 7 percent loss in body weight and 150 minutes per week of exercise, cost about $12,000 for each year of "quality-adjusted" life -- meaning it cost that much to purchase one year of life in good health.

Herman said those costs are in line with standard treatments such as beta-blockers for people who have had a heart attack or drugs for people with severely high blood pressure.

The investigator also said costs of the lifestyle intervention program tapered off in later years, with no drop in effectiveness, and costs could be lower if interventions were in a group format, rather than individualized plans.

Meigs said most patients found to be at high risk of developing diabetes prefer trying to lose weight and exercise before resorting to pills.